Acute gastrointestinal bleeding: CT angiography with multi-planar reformatting

Abstract

Acute gastrointestinal bleeding is a common medical emergency, which carries a significant mortality. CT Angiography is an important non-invasive diagnostic tool, which can be used to plan subsequent endovascular or surgical management. The cases presented demonstrate that a meticulous and systematic approach to image interpretation is necessary, in particular, to detect focal sites of contrast extravasation and small pseudoaneurysms.

The role of enhanced multi‐detector‐row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding

“…One of the reasons for this is that some cases with a small amount of bleeding, such as esophagitis, angioectasia, shallow ulcer, and ulcer with a nonbleeding visible vessel, were also included in this study. These cases could not be confirmed as active bleeding by enhanced MDCT, as CT angiography has been reported to be useful for detecting bleeding only at a rate of > 0.3 mL/min . Furthermore, shallow ulcers might not affect the surrounding mucosa, so may not be detectable by MDCT.…”

“…These cases could not be confirmed as active bleeding by enhanced MDCT, as CT angiography has been reported to be useful for detecting bleeding only at a rate of > 0.3 mL/min. 10 Furthermore, shallow ulcers might not affect the surrounding mucosa, so may not be detectable by MDCT. Another reason for the lower accuracy in the present study might be that most of the MDCT scans were obtained only during the portal phase or arterial phase.…”

Multidetector CT Angiography for Acute Gastrointestinal Bleeding: Technique and Findings

“…The clinical manifestations of gastrointestinal hemorrhage depend on the location of the source, the rate of bleeding, and the effect of blood loss on the general condition of the patient. These factors dictate the priority and the order in which diagnostic tests and therapeutic procedures should be performed (17). Severe bleeding can cause hypovolemic shock, but slow and intermittent blood loss manifests most often with iron deficiency anemia or stools with positive findings on a fecal occult blood test (Hemoccult; Beckman Coulter, Brea, Calif).…”

“…Hospitalization is usually required in elderly patients and those presenting with hemodynamic instability or severe comorbidities (17). However, only 20% of the patients with acute gastrointestinal bleeding will need urgent intervention.…”

Diagnostic Modalities in Gastrointestinal Bleeding

“…Advancements in multidetector CT technology have greatly enhanced the ability of CT to localize GI bleeding. [10][11][12] Triple-phase CT angiography rapidly acquires images in a precontrast phase, an arterial phase, and a portal phase taken about 90 seconds after the intravenous (IV) contrast injection. High resolution axial images (narrow collimation) are obtained in a standard multiplanar format with axial, coronal, and sagittal views and the software also allows the radiologist to view customized maximum intensity reconstructions (MIP images) that are essentially oblique cuts that allow the optimal plane to be chosen to best display a specific anatomic structure focused on the site of contrast extravasation.…”